Ulnar deviation

File:AUD-Spange.jpg

A splint used for ulnar deviation

Ulnar deviation, also known as ulnar drift, is a hand deformity in which the fingers are displaced towards the ulna, the bone on the side of the forearm opposite the thumb. This condition is most commonly associated with rheumatoid arthritis, a chronic inflammatory disorder that primarily affects joints.

Pathophysiology

Ulnar deviation occurs due to the weakening of the ligaments and tendons that stabilize the metacarpophalangeal joints (MCP joints) of the hand. In rheumatoid arthritis, the synovial membrane that lines the joints becomes inflamed, leading to the destruction of cartilage and bone within the joint. This results in joint instability and the characteristic drift of the fingers towards the ulnar side.

Clinical Presentation

Patients with ulnar deviation often present with:

• Deviation of the fingers towards the ulnar side of the hand.
• Swelling and pain in the affected joints.
• Reduced range of motion and grip strength.
• Difficulty in performing fine motor tasks.

Diagnosis

Diagnosis of ulnar deviation is primarily clinical, based on the characteristic appearance of the hands. Imaging studies such as X-rays can be used to assess the extent of joint damage and to differentiate from other conditions that may cause similar deformities.

Management

Management of ulnar deviation involves both medical and surgical approaches:

Medical Management

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
• Disease-modifying antirheumatic drugs (DMARDs) to slow disease progression.
• Physical therapy to maintain joint function and improve hand strength.
• Use of splints or braces to support the joints and prevent further deformity.

Surgical Management

In severe cases, surgical intervention may be necessary. Options include:

• Synovectomy: Removal of the inflamed synovial tissue.
• Joint replacement or arthroplasty: Replacement of the damaged joint with a prosthesis.
• Tendon repair or transfer to restore hand function.

Prognosis

The prognosis for individuals with ulnar deviation depends on the underlying cause and the effectiveness of treatment. Early diagnosis and aggressive management of rheumatoid arthritis can help prevent or minimize the development of ulnar deviation.

Related Pages

• Rheumatoid arthritis
• Metacarpophalangeal joint
• Hand deformities